Rim Sun Hee, Hirsch Shawn, Thomas Cheryll C, Brewster Wendy R, Cooney Darryl, Thompson Trevor D, Stewart Sherri L
Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States.
SciMetrika LLC, Durham, NC 27713, United States.
World J Obstet Gynecol. 2016;5(2):187-196. doi: 10.5317/wjog.v5.i2.187. Epub 2016 May 10.
To examine the influence of gynecologic oncologists (GO) in the United States on surgical/chemotherapeutic standard of care (SOC), and how this translates into improved survival among women with ovarian cancer (OC).
Surveillance, Epidemiology, and End Result (SEER)-Medicare data were used to identify 11688 OC patients (1992-2006). Only Medicare recipients with an initial surgical procedure code ( = 6714) were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Multivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.
About 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC ( < 0.01). Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22 (95%CI: 1.12-1.33), < 0.01], and also was higher among women seen by non-GOs GOs (for surgical treatment) after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC.
A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.
研究美国妇科肿瘤学家（GO）对手术/化疗标准治疗（SOC）的影响，以及这如何转化为卵巢癌（OC）女性患者生存率的提高。
使用监测、流行病学和最终结果（SEER）-医疗保险数据识别11688例OC患者（1992 - 2006年）。仅纳入具有初始手术程序代码（= 6714）的医疗保险受益患者。通过将SEER-医疗保险与美国医学协会主文件链接来确定医生专业。SOC由一组妇科肿瘤学家定义。使用多变量逻辑回归确定接受手术/化疗SOC的预测因素，并使用比例风险模型估计SOC治疗和医生专业对生存的影响。
约34%的患者接受了妇科肿瘤学家的手术，25%的患者接受了整体SOC。三分之一的女性在其治疗过程中的某个时间有妇科肿瘤学家参与。接受妇科肿瘤学家而非非妇科肿瘤学家手术的女性接受手术SOC的几率是2.35倍，接受化疗SOC的几率是1.25倍（P < 0.01）。与接受手术SOC的女性相比，未接受手术SOC的女性死亡风险更高[风险比 = 1.22（95%CI：1.12 - 1.33），P < 0.01]，并且在调整协变量后，由非妇科肿瘤学家而非妇科肿瘤学家诊治（手术治疗）的女性死亡风险也更高。接受联合SOC的女性中位生存时间长14个月。
接受手术SOC和由妇科肿瘤学家进行整体治疗具有生存优势得到了支持。持续存在的生存差异，特别是在未接受SOC的患者中，需要进一步研究。
